原发纵隔恶性生殖细胞瘤32例临床分析

目的:探讨纵隔恶性生殖细胞瘤(malignant germ cell tumors,MGCT)的临床特点、治疗和预后。方法:32例纵隔MGCT患者,精原细胞瘤18例,非精原细胞瘤14例。所有患者均采用手术和(或)放疗和(或)化疗等多学科综合治疗的方法。结果:非精原细胞瘤患者中位生存期(OS)32.4个月,中位无进展生存期(PFS)18个月,5年无复发生存率和总生存率均为28.6%。精原细胞瘤患者5年无复发生存率和总生存率分别为83.3%和85.6%,中位OS和PFS均未到达。精原细胞瘤患者OS和PFS均明显好于非精原细胞瘤患者,P值分别为0.001 4和0.000 7。结论:纵隔精原细胞瘤采用多学科综合治疗方法能取得较好的治疗效果,本研究的结果与文献报道相符。纵隔非精原细胞瘤的治疗效果有待进一步提高。非精原细胞瘤是影响纵隔恶性生殖细胞瘤预后的重要因素。

Clinical analysis of 32 cases of primary malignant germ cell tumors in mediastinum

Objective:To analyze clinical features,treatment and prognosis of primary malignant germ cell tumors(MGCT) of mediastinum.Methods:Thirty-two patients with primary malignant germ cell tumors of mediastinum received multi-modality treatment such as surgery,radiotherapy and chemotherapy.There were 18 patients with seminomas and 14 patients with nonseminomatous germ cell tumors.Results:For patients with nonseminomatous germ cell tumors the median survival time was 32.4 months and the median progression-free survival(PFS) time was 18 months.Both the five-year disease free survival rate and the total survival rate were 28.6%.For patients with seminomas the five-year disease free survival rate was 83.3% and the total survival rate was 85.6%.And the median survival time and the progression-free survival time could not be calculated.Both the median survival time and the PFS time were longer in patients with seminomas than those with nonseminomatous germ cell tumors(P=0.0014 and 0.0007,respectively).Conclusion:Multi-modality treatment for patients with primary mediastinal seminomas achieves better clinical outcomes.Our results are in accordance with others' work reported in the literature.The therapeutic efficacy for nonseminomatous germ cell tumors should be improved.Nonseminomatous germ cell tumor is an important prognostic factor for mediastinal malignant tumors.